Provider Demographics
NPI:1235530932
Name:LEAKE, RUTH (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:LEAKE
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:MISS
Other - First Name:RUTH
Other - Middle Name:ANNE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:85 CLEBURNE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-4435
Mailing Address - Country:US
Mailing Address - Phone:540-674-4889
Mailing Address - Fax:540-674-1666
Practice Address - Street 1:85 CLEBURNE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-4435
Practice Address - Country:US
Practice Address - Phone:540-674-4889
Practice Address - Fax:540-674-1666
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001950237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist